Surgical Repair of Lateral and Anterolateral Hernias of the Abdominal Wall

Abstract

Objective: To improve the results of surgical treatment of primary, postoperative and recurrent hernias of the lateral and anterolateral abdominal wall. Methods: Various types of hernioplasty were performed in 68 patients with lateral and anterolateral hernias of the abdominal wall (LALHAW) aged 24 to 67 years. Primary hernias were diagnosed in 10 patients, postoperative – in 30, recurrent – in 28. There were 16 men and 52 women enrolled on the study. Analysis of the anamnesis and medical records revealed that postoperative hernias (30) arose after the following surgical interventions: nephrectomy (11), nephrolithomy (8), appendectomy (4), cholecystectomy (3), drainage of the retroperitoneal space (2), surgery for hepatic echinococcosis (1) and adrenalectomy (1); 24 patients were admitted with recurrent hernia after traditional hernioplasty, and 4 patients – after combined methods of hernioplasty. Results: Among the total number of patients, traditional hernioplasty was performed in 25 (36.8%) patients, tension-free repair – in 5 (7.4%) and combined repair – in 38 (55.8%) patients. Simultaneous operations were performed in 14 cases, such as nephrolithotomy (3), resection of the ovarian cyst (3) and greater omentum (5), supravaginal amputation of the uterus (3). Surgical site complications developed in 12% of cases after traditional hernioplasty, and in 5.2%. after combined methods of operation. Among 5 patients operated using a tension-free method, seroma occurred in one observation. Recurrent hernia after traditional hernioplasty developed in one patient (4% of cases). Conclusion: Surgical treatment of LALHAW is a complicated problem of herniology, due to the complexity of anatomical architectonics of the anterior abdominal wall and limited plastic resources of the surrounding tissues. Currently, the results of traditional hernioplasty remain disappointing, as there is a trend towards increased recurrence and incidence of surgical site complications after its application. The widespread use of the combined methods of surgical treatment of hernias of this localization, along with reliable reinforcement of the hernia defect, provide the most optimal longterm functional results, allowing the patients resume their previous professional activities. The incidence of recurrent hernias after these operations tends to reduce, contributing to an improvement in the quality of life. Keywords: Lateral abdominal hernia, anterolateral abdominal hernia, recurrent hernia, traditional hernioplasty, tension-free hernioplasty.